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Collins IC, Blanchard CT, Tipre M, Oben A, Robinson A, Kako T, Joly JM, Cribbs MG, Casey B, Tita A, Sinkey R. Breastfeeding Practices in Patients with Heart Disease Stratified by Area Deprivation Index. Breastfeed Med 2024; 19:256-261. [PMID: 38502815 DOI: 10.1089/bfm.2023.0295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Objective: We sought to evaluate breastfeeding (BF) practices in patients with maternal cardiac disease (MCD) stratified by area deprivation index (ADI) to identity communities at risk. Study Design: Retrospective cohort of patients managed by the University of Alabama at Birmingham (UAB) Cardio-Obstetrics Program. Patients were included if they had ≥1 prenatal visit with the Cardio-Obstetrics team, delivered at UAB, and had a street address on file. The primary outcome was BF rate at hospital discharge. Secondary outcomes included BF intent on admission and BF at the postpartum (PP) visit. ADI reports socioeconomic disadvantage at the census tract level; 1 = least deprived and 100 = most deprived. Baseline characteristics and BF rates were compared by ADI categories: Low (ADI 1-33), medium (ADI 34-66), and high (ADI 67-100). Results: One hundred and forty-eight patients were included: 14 (10%) low, 42 (28%) medium, and 92 (62%) high ADI. Patients in the high ADI category were younger relative to those in the medium or low ADI (26 versus 28 versus 32 years; p < 0.01) and less likely to be married or living with a partner (30.4% versus 58.5% versus 71.4%; p < 0.01), There was no difference in BF intent between the lowest, medium, and highest ADI categories (85.7% versus 85.4% versus 81.6%; p = 0.38) or BF rates at hospital discharge (100% versus 92.7% versus 85.6%, p = 0.23). However, there was a significant difference in BF rates at the PP visit (90% versus 63.0% versus 38.6%; p < 0.01) even after controlling for differences in baseline characteristics (odds ratio = 0.11 (95% confidence interval [0.01-0.93]), p = 0.043). Conclusions: There was an association between living in a resource-poor community and early cessation of BF in our population of patients with MCD. Community-based interventions targeting mothers with heart disease living in high ADI communities may help these individuals achieve higher BF rates.
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Affiliation(s)
- Isabel C Collins
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, Alabama, USA
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christina T Blanchard
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Meghan Tipre
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ayamo Oben
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Ashton Robinson
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, Alabama, USA
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tavonna Kako
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Joanna M Joly
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Marc G Cribbs
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Brian Casey
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Alan Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Rachel Sinkey
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
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Perino MT, Sylvester CM, Rogers CE, Luby JL, Barch DM. Neighborhood Resource Deprivation as a Predictor of Bullying Perpetration and Resource-Driven Conduct Symptoms. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00137-0. [PMID: 38522614 DOI: 10.1016/j.jaac.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 02/11/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Resource deprivation is linked to systemic factors that disproportionately impact historically marginalized communities, and theoretical work suggests that resource deprivation may increase risk for bullying behaviors. Bullying perpetration is an intransigent social problem and an early risk factor that perpetuates the school-to-prison pipeline. This study explored how resource deprivation (family- and neighborhood-level metrics) was associated with early childhood bullying behaviors and clinician-rated symptoms of psychopathology, while accounting for other known risk factors (early life stressors, traumatic events, parental arrest, domestic violence). METHOD Participants (306 children, mean age = 4.45 years) were enrolled in a longitudinal study (Preschool Depression Study) where demographics, clinician-rated assessments of psychopathology, and parent reports of social functioning were collected. Measures of bullying behaviors (bullying perpetration, generalized aggression, and victimization) were constructed. A cross-sectional approach was employed, and analyses examined the interrelations between race, bullying-related behaviors, resource deprivation, and psychopathology, while accounting for confounding variables, at the baseline assessment time point. RESULTS The bullying measure showed acceptable model fit (comparative fit index = 0.956, Tucker-Lewis index = 0.945, root mean square error of approximation = 0.061, standardized root mean squared error = 0.052, normed χ2 ratio = 2). Neighborhood resource deprivation was more strongly associated with bullying perpetration (r = 0.324, p < .001) than generalized aggression (r = 0.236, Williams t303 = 2.11, p = .036) and remained significant when controlling for other known risk factors (parental arrests, domestic violence, stressors, traumas) and demographic factors. Bullying perpetration was linked with racial category, but the relation was fully mediated by neighborhood resource deprivation. Linear regression including bullying behaviors and symptoms of clinical psychopathology suggested that resource deprivation specifically led to increases in bullying perpetration (t = 2.831, p = .005) and clinician-rated symptoms of conduct disorder (t = 2.827, p = .005), which were attributable to increased rates of resource-driven conduct symptoms (bullies, lies to obtain goods, stolen without confrontation). CONCLUSION Resource deprivation is strongly and specifically associated with increases in bullying perpetration. Children growing up in impoverished neighborhoods show significant increases in resource-driven conduct behaviors, yet interventions often target individual-level factors. These results highlight the need to target social inequity to reduce bullying perpetration and suggest that interventions targeting neighborhoods should be tested to reduce bullying in early childhood. DIVERSITY & INCLUSION STATEMENT We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. One or more of the authors of this paper received support from a program designed to increase minority representation in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.
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Affiliation(s)
- Michael T Perino
- Washington University School of Medicine in St. Louis, St. Louis, Missouri.
| | - Chad M Sylvester
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Cynthia E Rogers
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Joan L Luby
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Deanna M Barch
- Washington University School of Medicine in St. Louis, St. Louis, Missouri; Washington University in St. Louis, St. Louis, Missouri
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Malik NH, Montero M, Chen JJ, Sinha S, Yom SS, Chan JW. Higher area deprivation index is associated with poorer local control and overall survival in non-metastatic nasopharyngeal carcinoma. Head Neck 2024. [PMID: 38517113 DOI: 10.1002/hed.27751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Neighborhood socioeconomic deprivation impacts outcomes in various cancers. We examined this association in nasopharyngeal carcinoma (NPC) patients using the area deprivation index (ADI). METHODS We conducted a single-institution retrospective cohort study on NPC patients treated with definitive radiotherapy from 1980 to 2023. ADI was used as the primary exposure measure. Higher ADI indicates higher levels of socioeconomic deprivation. RESULTS Of 561 patients, those with higher ADI (6-10 vs. 1-5) presented more commonly with AJCC stage III/IV compared to I/II (87% vs. 76%, p = 0.03). Increasing ADI decile score correlated with poorer overall survival (HR 1.14, 95% CI 1.01-1.28, p = 0.04). Local control was worse in patients from the most deprived quartile in the cohort ADI 5-10 (HR 2.11, 95% CI 1.01-4.41, p = 0.05). CONCLUSIONS NPC patients from more disadvantaged neighborhoods undergoing radiotherapy had worse local control and survival outcomes. Interventions to address structural determinants of health and neighborhood disparities may improve these outcomes.
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Affiliation(s)
- Nauman H Malik
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California, USA
| | | | - Jie Jane Chen
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California, USA
| | - Sumi Sinha
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California, USA
| | - Sue S Yom
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California, USA
| | - Jason W Chan
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California, USA
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Ferraro SL, Dance S, Rajabi D, Elabd A, Tabaie S. Equity in the Developmental Dysplasia of the Hip (DDH) Diagnosis and Treatment: A Retrospective Cohort Study to Unravel the Effect of Area Deprivation and the Insurance Type. Cureus 2024; 16:e56956. [PMID: 38533323 PMCID: PMC10964837 DOI: 10.7759/cureus.56956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 03/28/2024] Open
Abstract
Background Timely diagnosis of developmental dysplasia of the hip (DDH) is crucial for implementing less invasive treatment. However, socioeconomic barriers may lead to late diagnoses. The Area Deprivation Index (ADI) is an indicator of the socioeconomic challenges experienced by patients and their families. The primary objective is to investigate if the age at which DDH is diagnosed and the treatment protocol are influenced by the ADI or the insurance type. Materials and methods Using International Classification of Diseases-Tenth Edition (ICD-10) codes, newly diagnosed DDH patients (age under 10 years) from 2020 to 2023 were retrospectively identified at our pediatric tertiary center. Patients were categorized into four groups based on ADI percentile: (1) 1-10th percentile, (2) 11-20th percentile, (3) 21-40th percentile, and (4) 41-100th percentile. They were also stratified by insurance type. Age at diagnosis and treatment protocol (non-operative vs. operative) were collected and compared between the different ADI groups and insurance groups. Operative treatment was defined as open reduction with or without femoral/pelvic osteotomy. Results A total of 327 patients satisfied the inclusion criteria and had available ADI scores for analysis. The average age at diagnosis was notably lower in ADI group 1 compared to all other ADI groups (p < 0.05) and considerably lower for patients with commercial insurance compared to those with public (p = 0.0002). The rate of surgical treatment was markedly lower in ADI group 1 compared to ADI groups 2 and 3 (both p < 0.05) and notably lower for those with commercial insurance compared to public (p = 0.0005). ADI groups 2-4 showed no significant differences in average age at diagnosis or surgical treatment rate. Conclusion The study demonstrates that socioeconomic factors affect the diagnosis and, consequently, the treatment course of DDH. Specifically, patients residing in areas with lower levels of deprivation tend to be diagnosed at a younger age and undergo surgical treatment less frequently.
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Affiliation(s)
- Samantha L Ferraro
- Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Sarah Dance
- Orthopaedic Surgery, Children's National Hospital, Washington DC, USA
| | - Delara Rajabi
- Orthopaedic Surgery, Children's National Hospital, Washington DC, USA
| | - Ahmed Elabd
- Orthopaedic Surgery, Children's National Hospital, Washington DC, USA
| | - Sean Tabaie
- Orthopaedic Surgery, Children's National Hospital, Washington DC, USA
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Lenoir KM, Paul R, Wright E, Palakshappa D, Pajewski NM, Hanchate A, Hughes JM, Gabbard J, Wells BJ, Dulin M, Houlihan J, Callahan KE. The Association of Frailty and Neighborhood Disadvantage with Emergency Department Visits and Hospitalizations in Older Adults. J Gen Intern Med 2024; 39:643-651. [PMID: 37932543 PMCID: PMC10973290 DOI: 10.1007/s11606-023-08503-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Risk stratification and population management strategies are critical for providing effective and equitable care for the growing population of older adults in the USA. Both frailty and neighborhood disadvantage are constructs that independently identify populations with higher healthcare utilization and risk of adverse outcomes. OBJECTIVE To examine the joint association of these factors on acute healthcare utilization using two pragmatic measures based on structured data available in the electronic health record (EHR). DESIGN In this retrospective observational study, we used EHR data to identify patients aged ≥ 65 years at Atrium Health Wake Forest Baptist on January 1, 2019, who were attributed to affiliated Accountable Care Organizations. Frailty was categorized through an EHR-derived electronic Frailty Index (eFI), while neighborhood disadvantage was quantified through linkage to the area deprivation index (ADI). We used a recurrent time-to-event model within a Cox proportional hazards framework to examine the joint association of eFI and ADI categories with healthcare utilization comprising emergency visits, observation stays, and inpatient hospitalizations over one year of follow-up. KEY RESULTS We identified a cohort of 47,566 older adults (median age = 73, 60% female, 12% Black). There was an interaction between frailty and area disadvantage (P = 0.023). Each factor was associated with utilization across categories of the other. The magnitude of frailty's association was larger than living in a disadvantaged area. The highest-risk group comprised frail adults living in areas of high disadvantage (HR 3.23, 95% CI 2.99-3.49; P < 0.001). We observed additive effects between frailty and living in areas of mid- (RERI 0.29; 95% CI 0.13-0.45; P < 0.001) and high (RERI 0.62, 95% CI 0.41-0.83; P < 0.001) neighborhood disadvantage. CONCLUSIONS Considering both frailty and neighborhood disadvantage may assist healthcare organizations in effectively risk-stratifying vulnerable older adults and informing population management strategies. These constructs can be readily assessed at-scale using routinely collected structured EHR data.
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Affiliation(s)
- Kristin M Lenoir
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA.
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Rajib Paul
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Elena Wright
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Deepak Palakshappa
- Section of General Internal Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of General Pediatrics, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Amresh Hanchate
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jaime M Hughes
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jennifer Gabbard
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Brian J Wells
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Michael Dulin
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Jennifer Houlihan
- Value Based Care and Population Health, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Kathryn E Callahan
- Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Yang W, Liu J, Chen Y, Hung AL, Sattari SA, Feghali J, Huang J. Association of socioeconomic status with the management outcome of unruptured intracranial arteriovenous malformation. J Neurosurg 2024:1-9. [PMID: 38364232 DOI: 10.3171/2023.12.jns232082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/08/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVE The longitudinal management of unruptured brain arteriovenous malformation (bAVM) is crucial. To date, no study in the United States has evaluated the impact of socioeconomic status (SES) on bAVM outcome. Herein, the authors aimed to clarify the impact of SES, as indicated by the area deprivation index (ADI), on bAVM outcome. METHODS A retrospective analysis of an institutional bAVM database was conducted. Non-hereditary hemorrhagic telangiectasia patients with a single unruptured bAVM in the period from 1990 to 2021 were included in the analysis. The ADI was categorized as low (ADI ≤ 15th percentile), mid (15th percentile < ADI < 85th percentile), and high (ADI ≥ 85th percentile), with a low ADI indicating the most advantaged group. Patient baseline and follow-up data were analyzed. The primary outcome of interest was nonindependence (modified Rankin Scale [mRS] score > 2) at the last follow-up. A multivariable logistic regression model was performed. RESULTS A total of 589 patients with unruptured bAVMs were included in the study. The mean patient age at diagnosis was 37.2 years, and 283 patients (48.0%) were male. Of the bAVMs, 238 (40.4%) had a low Spetzler-Martin grade (SMG < III), 194 (32.9%) had a moderate grade (SMG III), and 157 (26.7%) had a high grade (SMG > III). Sixty-nine patients (11.7%) were in the low-ADI group, 476 (80.8%) in the mid-ADI group, and 44 (7.5%) in high-ADI group. Increasing age (OR 1.02, 95% CI 1.01-1.04, p < 0.001), poor baseline mRS score (OR 3.27, 95% CI 1.32-7.88, p = 0.008), treatment with surgery plus radiosurgery with or without embolization (OR 3.21, 95% CI 1.03-9.81, p = 0.041), mid SMG (OR 1.94, 95% CI 1.11-3.44, p = 0.021), high SMG (OR 2.08, 95% CI 1.13-3.88, p = 0.020), longer follow-up (OR 1.05, 95% CI 1.03-1.08, p < 0.001), and mid ADI (OR 3.08, 95% CI 1.34-8.39, p = 0.015) were significantly associated with a poor outcome. A high ADI tended toward a poor outcome (OR 2.93, 95% CI 0.92-9.88, p = 0.071). Eventual obliteration of a bAVM was the only protective predictor of poor outcome (OR 0.55, 95% CI 0.30-0.98, p = 0.046). CONCLUSIONS This study revealed that relatively disadvantaged patients with unruptured bAVMs are more likely to experience nonindependent outcomes at the last follow-up, after adjusting for confounding variables. An emphasis on social support may be beneficial for patients with a lower SES.
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Affiliation(s)
- Wuyang Yang
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Jiaqi Liu
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
- 2Georgetown University School of Medicine, Washington, DC
| | - Yuxi Chen
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Alice L Hung
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Shahab Aldin Sattari
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - James Feghali
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Judy Huang
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
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Gaudet CE, Cook NE, Kissinger-Knox A, Liu B, Stephenson K, Berkner PD, Iverson GL. Neighborhood Disadvantage and Clinical Outcome Following Concussion in Adolescents. J Neurotrauma 2024; 41:475-485. [PMID: 37463069 DOI: 10.1089/neu.2023.0243] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Whether social determinants of health are associated with clinical outcome following concussion among adolescents is not well established. The present study examined whether neighborhood-level determinants are associated with clinical recovery time following concussion in adolescents. Participants included adolescent student athletes (n = 130; mean age = 16.6, standard deviation = 1.2; 60.8% boys, 39.2% girls) who attended one of nine selected high schools in Maine, USA. The Area of Deprivation Index (ADI), an indicator of neighborhood disadvantage was used to group high schools as either high or low in neighborhood disadvantage. Athletic trainers entered injury and recovery dates into an online surveillance application between September 2014 and January 2020. Chi-squared analyses and Kaplan-Meier survival analyses were used to compare the groups on two clinical outcomes: days to return to school and days to return to sports. Results of chi-squared tests did not reveal between-group differences in return to school at 21 or 28 days. However, groups differed in the percentage of adolescents who had returned to sports by 21 days (greater neighborhood disadvantage, 62.5%, lesser neighborhood disadvantage 82.0%, χ2 = 4.96, p = 0.03, odds ratio [OR] = 2.73, 95% confidence interval [CI], 1.11-6.74) and 28 days (greater neighborhood disadvantage, 78.6%, lesser neighborhood disadvantage 94.0%, χ2 = 5.18, p = 0.02, OR = 4.27, 95% CI, 1.13-16.16) following concussion. A larger proportion of adolescents attending schools located in areas of greater neighborhood disadvantage took more than 21 and 28 days to return to sports. These results indicate an association between a multi-faceted proxy indicator of neighborhood disadvantage and clinical outcome following concussion. Further research is needed to better characterize factors underlying group differences in time to return to sports and the interactions between neighborhood disadvantage and other correlates of clinical recovery following concussion.
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Affiliation(s)
- Charles E Gaudet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- MassGeneral Hospital for Children Sports Concussion Program, Waltham, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- MassGeneral Hospital for Children Sports Concussion Program, Waltham, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Alicia Kissinger-Knox
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- MassGeneral Hospital for Children Sports Concussion Program, Waltham, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Brian Liu
- MassGeneral Hospital for Children Sports Concussion Program, Waltham, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Katie Stephenson
- College of Osteopathic Medicine, University of New England, Biddeford, Maine, USA
| | - Paul D Berkner
- College of Osteopathic Medicine, University of New England, Biddeford, Maine, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- MassGeneral Hospital for Children Sports Concussion Program, Waltham, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Schoen Adams Research Institute, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
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Gornik AE, Northrup RA, Kalb LG, Jacobson LA, Lieb RW, Peterson RK, Wexler D, Ludwig NN, Ng R, Pritchard AE. To confirm your appointment, please press one: Examining demographic and health system interface factors that predict missed appointments in a pediatric outpatient neuropsychology clinic. Clin Neuropsychol 2024; 38:279-301. [PMID: 37291078 DOI: 10.1080/13854046.2023.2219421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
Objective: Missed patient appointments have a substantial negative impact on patient care, child health and well-being, and clinic functioning. This study aims to identify health system interface and child/family demographic characteristics as potential predictors of appointment attendance in a pediatric outpatient neuropsychology clinic. Method: Pediatric patients (N = 6,976 across 13,362 scheduled appointments) who attended versus missed scheduled appointments at a large, urban assessment clinic were compared on a broad array of factors extracted from the medical record, and the cumulative impact of significant risk factors was examined. Results: In the final multivariate logistic regression model, health system interface factors that significantly predicted more missed appointments included a higher percentage of previous missed appointments within the broader medical center, missing pre-visit intake paperwork, assessment/testing appointment type, and visit timing relative to the COVID-19 pandemic (i.e. more missed appointments prior to the pandemic). Demographic characteristics that significantly predicted more missed appointments in the final model included Medicaid (medical assistance) insurance and greater neighborhood disadvantage per the Area Deprivation Index (ADI). Waitlist length, referral source, season, format (telehealth vs. in-person), need for interpreter, language, and age were not predictive of appointment attendance. Taken together, 7.75% of patients with zero risk factors missed their appointment, while 22.30% of patients with five risk factors missed their appointment. Conclusions: Pediatric neuropsychology clinics have a unique array of factors that impact successful attendance, and identification of these factors can help inform policies, clinic procedures, and strategies to decrease barriers, and thus increase appointment attendance, in similar settings.
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Affiliation(s)
- Allison E Gornik
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
| | - Rachel A Northrup
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Luther G Kalb
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Lisa A Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
| | - Rebecca W Lieb
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
| | - Rachel K Peterson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
| | - Danielle Wexler
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Natasha N Ludwig
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
| | - Rowena Ng
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
| | - Alison E Pritchard
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
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9
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Kim U, Hoehn RS, Schwartz GK, Cullen J, Bordeaux JS, Mangla A, Carroll BT. Evaluating disruptions in melanoma diagnosis resulting from the COVID-19 pandemic from a community-based perspective. J Am Acad Dermatol 2024; 90:147-150. [PMID: 37666421 DOI: 10.1016/j.jaad.2023.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Affiliation(s)
- Uriel Kim
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
| | - Richard S Hoehn
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Gary K Schwartz
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Jennifer Cullen
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Jeremy S Bordeaux
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Ankit Mangla
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Division of Hematology and Oncology, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Bryan T Carroll
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Ye IB, Thomson AE, Chowdhury N, Oster B, Miseo VS, Jauregui JJ, Cavanaugh D, Koh E, Gelb D, Ludwig S. Telemedicine Improves Access to Care for Spine Patients With Low Socioeconomic Status. Global Spine J 2024; 14:49-55. [PMID: 35403457 PMCID: PMC9006097 DOI: 10.1177/21925682221092398] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The objective of this study is to compare the likelihood of missing a scheduled telemedicine and in-person appointments for spine patients. The secondary objective is to assess the impact of socioeconomic status on missed telemedicine and in-person appointments. METHODS Patients with scheduled outpatient appointments with orthopedic spine faculty between 2019 and 2021 were divided by appointment type: telemedicine (N = 4,387) and in-person (N = 3810). Socioeconomic status was assessed using Area Deprivation Index (ADI) stratified based on percentile: low (<25), medium (25-75), and high (>75) levels of socioeconomic disadvantage. The primary outcome measure was missed clinic appointments, which was defined as having at least one appointment that was cancelled or labeled "no show." RESULTS Patients with in-person appointments missed appointments more often than patients with telemedicine visits (51.3% vs 24.7%, P < .001). Patients with high ADI missed their in-person appointments more often than patients with medium and low ADI (59.5% vs 52.2% and 47.5%, P < .001). There was no difference in missed telemedicine visits between patients with high, medium, and low ADI (27.6% vs 24.8% vs 23.8%, P = .294). Patients that missed an appointment were 41.9% more likely to be high ADI (OR 1.42, 95% CI 1.20-1.68, P < .001) and 13.4% more likely to be medium ADI (OR 1.13, 95% CI 1.03-1.26, P = .015) compared with low ADI patients. CONCLUSIONS Telemedicine may serve a role in reducing disparity in appointment attendance. While further studies are needed to validate these findings, spine surgeons should consider offering telemedicine as an option to patients.
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Affiliation(s)
- Ivan B. Ye
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Alexandra E. Thomson
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Navid Chowdhury
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Brittany Oster
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Vincent S. Miseo
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Julio J. Jauregui
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Daniel Cavanaugh
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Eugene Koh
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Daniel Gelb
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Steven Ludwig
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
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11
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Lusk JB, Hoffman MN, Clark AG, Mahoney H, Blass B, Bae J, Ashana DC, Cox CE, Hammill BG. Neighborhood Socioeconomic Disadvantage, Healthcare Access, and Outcomes of Hospitalizations for Common Pulmonary Conditions: A National Study of Medicare Beneficiaries. Ann Am Thorac Soc 2023; 20:1416-1424. [PMID: 37343304 DOI: 10.1513/annalsats.202304-310oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/21/2023] [Indexed: 06/23/2023] Open
Abstract
Rationale: Understanding how systemic forces and environmental exposures impact patient outcomes is critical to advancing health equity and improving population health for patients with pulmonary disease. This relationship has not yet been assessed at the population level nationally. Objectives: To determine whether neighborhood socioeconomic deprivation is independently associated with 30-day mortality and readmission for hospitalized patients with pulmonary conditions, after controlling for demographics, access to healthcare resources, and characteristics of admitting healthcare facilities. Methods: This was a retrospective, population-level cohort study of 100% of United States nationwide Medicare inpatient and outpatient claims from 2016-2019. Patients were admitted for one of four pulmonary conditions (pulmonary infections, chronic lower respiratory disease, pulmonary embolism, and pleural and interstitial lung diseases), defined by diagnosis-related group. The primary exposure was neighborhood socioeconomic deprivation, measured by the area deprivation index. The main outcomes were 30-day mortality and 30-day unplanned readmission, defined by Centers for Medicare and Medicaid Services methodologies. Generalized estimating equations were used to estimate logistic regression models for the primary outcomes, addressing clustering by hospital. A sequential adjustment strategy was first adjusted for age, legal sex, Medicare-Medicaid dual eligibility, and comorbidity burden, then adjusted for metrics of access to healthcare resources, and finally adjusted for characteristics of the admitting healthcare facility. Results: After full adjustment, patients from low socioeconomic status neighborhoods had greater 30-day mortality after admission for pulmonary embolism (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.13-1.40), respiratory infections (OR, 1.20; 95% CI, 1.16-1.25), chronic lower respiratory disease (OR, 1.31; 95% CI, 1.22-1.41), and interstitial lung disease (OR, 1.15; 95% CI, 1.04-1.27) when compared to patients from the highest SES neighborhoods. Low neighborhood socioeconomic status was also associated with 30-day readmission for all groups except the interstitial lung disease group. Conclusions: Neighborhood socioeconomic deprivation may be a key factor driving poor health outcomes for patients with pulmonary diseases.
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Affiliation(s)
- Jay B Lusk
- Duke University School of Medicine
- Duke University Fuqua School of Business
| | | | - Amy G Clark
- Duke University Department of Population Health Sciences
| | - Hannah Mahoney
- Duke University Department of Population Health Sciences
| | | | - Jonathan Bae
- Duke University Health System, and
- Duke University Department of Medicine, Duke University, Durham, North Carolina
| | - Deepshikha C Ashana
- Duke University Department of Medicine, Duke University, Durham, North Carolina
| | - Christopher E Cox
- Duke University Department of Medicine, Duke University, Durham, North Carolina
| | - Bradley G Hammill
- Duke University School of Medicine
- Duke University Department of Population Health Sciences
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Lizzappi M, Bronheim RS, Raad M, Hicks CW, Skolasky RL, Riley LH, Lee SH, Jain A. Association of Neighborhood Socioeconomic Deprivation With Utilization and Costs of Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976) 2023; 48:1272-1281. [PMID: 37417689 PMCID: PMC10527499 DOI: 10.1097/brs.0000000000004769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/17/2023] [Indexed: 07/08/2023]
Abstract
STUDY DESIGN A retrospective analysis. OBJECTIVE The aim of our study was to analyze the association of Area Deprivation Index (ADI) with the utilization and costs of elective anterior cervical discectomy and fusion (ACDF) surgery. SUMMARY OF BACKGROUND DATA ADI, a comprehensive neighborhood-level measure of socioeconomic disadvantage, has been shown to be associated with worse perioperative outcomes in a variety of surgical settings. MATERIALS AND METHODS The Maryland Health Services Cost Review Commission Database was queried to identify patients who underwent primary elective ACDF between 2013 and 2020 in the state. Patients were stratified into tertiles by ADI, from least disadvantaged (ADI1) to most disadvantaged (ADI3). The primary endpoints were ACDF utilization rates per 100,000 adults and episode-of-care total costs. Univariable and multivariable regression analyses were performed. RESULTS A total of 13,362 patients (4984 inpatient and 8378 outpatient) underwent primary ACDF during the study period. In our study, there were 2,401 (17.97%) patients residing in ADI1 neighborhoods (least deprived), 5974 (44.71%) in ADI2, and 4987 (37.32%) in ADI3 (most deprived). Factors associated with increased surgical utilization were increasing ADI, outpatient surgical setting, non-Hispanic ethnicity, current tobacco use, and diagnoses of obesity and gastroesophageal reflux disease. Factors associated with lower surgical utilization were: non-white race, rurality, Medicare/Medicaid insurance status, and diagnoses of cervical disk herniation or myelopathy. Factors associated with higher costs of care were increasing ADI, older age, Black/African American race, Medicare or Medicaid insurance, former tobacco use, and diagnoses of ischemic heart disease and cervical myelopathy. Factors associated with lower costs of care were outpatient surgical setting, female sex, and diagnoses of gastroesophageal reflux disease and cervical disk herniation. CONCLUSIONS Neighborhood socioeconomic deprivation is associated with increased episode-of-care costs in patients undergoing ACDF surgery. Interestingly, we found greater utilization of ACDF surgery among patients with higher ADI. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Malcolm Lizzappi
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Rachel S. Bronheim
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Caitlin W. Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Richard L. Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Lee H. Riley
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Sang H. Lee
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Amit Jain
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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Dileep A, Warren C, Bilaver LA, Gupta RS, Mahdavinia M. Understanding how socioeconomic determinants affect the development of allergy to common foods in children. Ann Allergy Asthma Immunol 2023; 131:393-395. [PMID: 37343825 PMCID: PMC10527777 DOI: 10.1016/j.anai.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/10/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Anandu Dileep
- Division of Allergy/Immunology, Rush University Medical Center, Chicago, Illinois
| | - Christopher Warren
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Lucy A Bilaver
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ruchi S Gupta
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Mahboobeh Mahdavinia
- Division of Allergy/Immunology, Rush University Medical Center, Chicago, Illinois.
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14
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Kim J, Kou Y, Chorney SR, Mitchell RB, Johnson RF. Assessment of neighborhood-level disadvantage and pediatric obstructive sleep apnea severity. Laryngoscope Investig Otolaryngol 2023; 8:1114-1123. [PMID: 37621268 PMCID: PMC10446263 DOI: 10.1002/lio2.1098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/08/2023] [Accepted: 06/09/2023] [Indexed: 08/26/2023] Open
Abstract
Objectives To examine the relationship between neighborhood-level advantage and severe obstructive sleep apnea (OSA) in children. Methods A retrospective case-control study was conducted on 249 children who underwent adenotonsillectomy and had full-night polysomnography conducted within 6 months prior. Patients were divided into more or less socioeconomically disadvantaged groups using a validated measure, the area deprivation index (ADI). The primary outcomes were the relationship between the apnea-hypopnea index (AHI) and the presence of severe OSA, and the secondary outcome was residual moderate or greater OSA after tonsillectomy. Results Of the 249 children included in the study, 175 (70.3%) were socially disadvantaged (ADI > 50). The median (interquartile range [IQR]) age was 9.4 (7.3-12.3) years, 129 (51.8%) were male, and the majority were White (151, 60.9%), Black (51, 20.6%), and/or of Hispanic (155, 62.5%) ethnicity. A total of 140 (56.2%) children were obese. The median (IQR) AHI was 8.9 (3.9-20.2). There was no significant difference in the median AHI or the presence of severe OSA between the more and less disadvantaged groups. Severe OSA was found to be associated with obesity (odds ratio [OR] = 3.13, 95% confidence interval [CI] = 1.83-5.34), and residual moderate or greater OSA was associated with older age (OR = 1.20, 95% CI = 1.05-1.38). Conclusions The ADI was not significantly associated with severe OSA or residual OSA in this cohort of children. Although more neighborhood-level disadvantage may increase the risk of comorbidities associated with OSA, it was not an independent risk factor in this study. Level of Evidence Level 4.
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Affiliation(s)
- Jenny Kim
- Department of OtolaryngologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Yann‐Fuu Kou
- Department of OtolaryngologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Pediatric OtolaryngologyChildren's Medical Center DallasDallasTexasUSA
| | - Stephen R. Chorney
- Department of OtolaryngologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Pediatric OtolaryngologyChildren's Medical Center DallasDallasTexasUSA
| | - Ron B. Mitchell
- Department of OtolaryngologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Pediatric OtolaryngologyChildren's Medical Center DallasDallasTexasUSA
| | - Romaine F. Johnson
- Department of OtolaryngologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Pediatric OtolaryngologyChildren's Medical Center DallasDallasTexasUSA
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15
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Ryu E, Wi CI, Wheeler PH, King KS, Carlson RE, Juhn YJ, Takahashi PY. The Role of Individual-Level Socioeconomic Status on Nursing Home Placement Accounting for Neighborhood Characteristics. J Am Med Dir Assoc 2023; 24:1048-1053.e2. [PMID: 36841262 PMCID: PMC10962058 DOI: 10.1016/j.jamda.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE Independent living is desirable for many older adults. Although several factors such as physical and cognitive functions are important predictors for nursing home placement (NHP), it is also reported that socioeconomic status (SES) affects the risk of NHP. In this study, we aimed to examine whether an individual-level measure of SES is associated with the risk of NHP after accounting for neighborhood characteristics. DESIGN A population-based study (Olmsted County, Minnesota, USA). SETTING AND PARTICIPANTS Older adults (age 65+ years) with no prior history of NHP. METHODS Electronic health records (EHR) were used to identify individuals with any NHP between April 1, 2012 (baseline date) and April 30, 2019. Association between the (HOUsing-based index of SocioEconomic Status (HOUSES) index, an individual-level SES measure based on housing characteristics of current residence, and risk of NHP was tested using random effects Cox proportional hazard model adjusting for area deprivation index (ADI), an aggregated SES measure that captures neighborhood characteristics, and other pertinent confounders such as age and chronic disease burden. RESULTS Among 15,031 older adults, 3341 (22.2%) experienced NHP during follow-up period (median: 7.1 years). At baseline date, median age was 73 years old with 55% female persons, 91% non-Hispanic Whites, and median number of chronic conditions of 4. Accounting for pertinent confounders, the HOUSES index was strongly associated with risk of NHP (hazard ratio 1.89; 95% confidence interval 1.66‒2.15 for comparing the lowest vs highest quartiles), which was not influenced by further accounting for ADI. CONCLUSIONS AND IMPLICATIONS This study demonstrates that an individual-level SES measure capturing current individual-specific socioeconomic circumstances plays a significant role for predicting NHP independent of neighborhood characteristics where they reside. This study suggests that older adults who are at higher risk of NHP can be identified by utilizing the HOUSES index and potential individual-level intervention strategies can be applied to reduce the risk for those with higher risk.
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Affiliation(s)
- Euijung Ryu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Philip H Wheeler
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Katherine S King
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Rachel E Carlson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Paul Y Takahashi
- Division of Primary Care and Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Charkowick SV, Logothetis CN, Tsay K, Jordan A, Hanna C, Zhang S, Coughlin E, Weppelmann TA, Mhaskar R, Oxner A. A Retrospective Analysis of Vitamin D Levels in Hospitalized COVID-19 Patients With Suspected Pulmonary Embolism. Cureus 2023; 15:e41805. [PMID: 37575807 PMCID: PMC10422855 DOI: 10.7759/cureus.41805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Despite using anti-coagulation therapy in hospitalized coronavirus disease 2019 (COVID-19) patients, they have high rates of pulmonary embolism (PE) and deep vein thrombosis (DVT). The main objective of this study was to evaluate the association between vitamin D deficiency and thrombotic events (defined as the occurrence of a new PE or DVT) in hospitalized COVID-19 patients. Materials and Methods This was a retrospective, cross-sectional study of 208 hospitalized COVID-19 patients who received a computed tomographic pulmonary angiography (CTPA) based on clinical suspicion of PE between January 1, 2020, and February 5, 2021. A <20 ng/mL serum vitamin D level was used to categorize vitamin D deficiency. Nonparametric tests and multivariate binary logistic regression were used to evaluate the association between serum vitamin D levels and clinical outcomes. Results The mean vitamin D level was 26.7±13.0 ng/mL (n=208), and approximately one-third of patients were vitamin D deficient (n=68, 32.7%). No association was found between vitamin D deficiency and the occurrence of thrombotic events. The incidence of PE was 19.1% in vitamin D deficient patients compared to 11.4% in vitamin D sufficient patients (p=0.13). Vitamin D deficiency was positively associated with ICU admission (OR 3.047, 95%CI 1.57-5.91, p=0.001) and mortality (OR 3.76, 95%CI 1.29-11.01, p=0.016). Conclusions This study found no association between vitamin D deficiency and the occurrence of a new PE or DVT in hospitalized COVID-19 patients. Patients with vitamin D deficiency were more likely to be admitted to the ICU and had increased overall mortality.
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Affiliation(s)
- Shaun V Charkowick
- College of Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Constantine N Logothetis
- Department of Internal Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Katherine Tsay
- College of Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Aryanna Jordan
- Department of Internal Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Catherine Hanna
- College of Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Sherry Zhang
- College of Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
- Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, USA
| | - Emily Coughlin
- College of Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Thomas A Weppelmann
- Department of Ophthalmology, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Asa Oxner
- Department of Internal Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
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Odani S, Tabuchi T, Nakaya T, Morishima T, Nakata K, Kuwabara Y, Saito MK, Ma C, Miyashiro I. Socioeconomic disparities in cancer survival: Relation to stage at diagnosis, treatment, and centralization of patients to accredited hospitals, 2005-2014, Japan. Cancer Med 2023; 12:6077-6091. [PMID: 36229942 PMCID: PMC10028172 DOI: 10.1002/cam4.5332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/09/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Cancer survival varies by socioeconomic status in Japan. We examined the extent to which survival disparities are explained by factors relevant to cancer control measures (promoting early-stage detection, standardizing treatment, and centralizing patients to government-accredited cancer hospitals [ACHs]). METHODS From the Osaka Cancer Registry, patients diagnosed with solid malignant tumors during 2005-2014 and aged 15-84 years (N = 376,077) were classified into quartiles using the Area Deprivation Index (ADI). Trends in inequalities were assessed for potentially associated factors: early-stage detection, treatment modality, and utilization of ACH (for first contact/diagnosis/treatment). 3-year all-cause survival was computed by the ADI quartile. Multivariable Cox regression models were used to assess survival disparities and their trends through a series of adjustment for the potentially associated factors. RESULTS During 2005-2014, the most deprived ADI quartile had lower rates than the least deprived quartile for early-stage detection (42.6% vs. 48.7%); receipt of surgery (58.1% vs. 64.1%); and utilization of ACH (83.5% vs. 88.4%). While rate differences decreased for receipt of surgery and utilization of ACH (Annual Percent Change = -3.2 and - 11.9, respectively) over time, it remained unchanged for early-stage detection. During 2012-2014, the most deprived ADI quartile had lower 3-year survival than the least deprived (59.0% vs. 69.4%) and higher mortality (Hazard Ratio [HR] = 1.32, adjusted for case-mix): this attenuated with additional adjustment for stage at diagnosis (HR = 1.23); treatment modality (HR = 1.20); and utilization of ACH (HR = 1.19) CONCLUSIONS: Despite improvements in equalizing access to quality cancer care during 2005-2014, survival disparities remained. Interventions to reduce inequalities in early-stage detection could ameliorate such gaps.
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Affiliation(s)
- Satomi Odani
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
- Department of Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Tomoki Nakaya
- Graduate School of Environmental Studies, Tohoku University, Sendai, Japan
| | | | - Kayo Nakata
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Yoshihiro Kuwabara
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | | | - Chaochen Ma
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
- Department of Oncology, Osaka University Graduate School of Medicine, Suita, Japan
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Prabhakaran D, Day GS, Munipalli B, Rush BK, Pudalov L, Niazi SK, Brennan E, Powers HR, Durvasula R, Athreya A, Blackmon K. Neurophenotypes of COVID-19: risk factors and recovery outcomes. Res Sq 2023:rs.3.rs-2363210. [PMID: 36597538 PMCID: PMC9810229 DOI: 10.21203/rs.3.rs-2363210/v2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Coronavirus disease 2019 (COVID-19) infection is associated with risk of persistent neurocognitive and neuropsychiatric complications, termed "long COVID". It is unclear whether the neuropsychological manifestations of COVID-19 present as a uniform syndrome or as distinct neurophenotypes with differing risk factors and recovery outcomes. We examined post-acute neuropsychological profiles following SARS-CoV-2 infection in 205 patients recruited from inpatient and outpatient populations, using an unsupervised machine learning cluster analysis, with objective and subjective measures as input features. This resulted in three distinct post-COVID clusters. In the largest cluster (69%), cognitive functions were within normal limits, although mild subjective attention and memory complaints were reported. Vaccination was associated with membership in this "normal cognition" phenotype. Cognitive impairment was present in the remaining 31% of the sample but clustered into two differentially impaired groups. In 16% of participants, memory deficits, slowed processing speed, and fatigue were predominant. Risk factors for membership in the "memory-speed impaired" neurophenotype included anosmia and more severe COVID-19 infection. In the remaining 15% of participants, executive dysfunction was predominant. Risk factors for membership in this milder "dysexecutive" neurophenotype included disease-nonspecific factors such as neighborhood deprivation and obesity. Recovery outcomes at 6-month follow-up differed across neurophenotypes, with the normal cognition group showing improvement in verbal memory and psychomotor speed, the dysexecutive group showing improvement in cognitive flexibility, and the memory-speed impaired group showing no objective improvement and relatively worse functional outcomes compared to the other two clusters. These results indicate that there are multiple post-acute neurophenotypes of long COVID, with different etiological pathways and recovery outcomes. This information may inform phenotype-specific approaches to treatment.
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Prabhakaran D, Day G, Munipalli B, Rush B, Pudalov L, Niazi S, Brennan E, Powers H, Durvasula R, Athreya A, Blackmon K. Neurophenotypes of COVID-19: risk factors and recovery outcomes. Res Sq 2023:rs.3.rs-2363210. [PMID: 36597538 PMCID: PMC9810229 DOI: 10.21203/rs.3.rs-2363210/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Coronavirus disease 2019 (COVID-19) infection is associated with risk of persistent neurocognitive and neuropsychiatric complications, termed "long COVID". It is unclear whether the neuropsychological manifestations of COVID-19 present as a uniform syndrome or as distinct neurophenotypes with differing risk factors and recovery outcomes. We examined post-acute neuropsychological profiles following SARS-CoV-2 infection in 205 patients recruited from inpatient and outpatient populations, using an unsupervised machine learning cluster analysis, with objective and subjective measures as input features. This resulted in three distinct post-COVID clusters. In the largest cluster (69%), cognitive functions were within normal limits, although mild subjective attention and memory complaints were reported. Vaccination was associated with membership in this "normal cognition" phenotype. Cognitive impairment was present in the remaining 31% of the sample but clustered into two differentially impaired groups. In 16% of participants, memory deficits, slowed processing speed, and fatigue were predominant. Risk factors for membership in the "memory-speed impaired" neurophenotype included anosmia and more severe COVID-19 infection. In the remaining 15% of participants, executive dysfunction was predominant. Risk factors for membership in this milder "dysexecutive" neurophenotype included disease-nonspecific factors such as neighborhood deprivation and obesity. Recovery outcomes at 6-month follow-up differed across neurophenotypes, with the normal cognition group showing improvement in verbal memory and psychomotor speed, the dysexecutive group showing improvement in cognitive flexibility, and the memory-speed impaired group showing no objective improvement and relatively worse functional outcomes compared to the other two clusters. These results indicate that there are multiple post-acute neurophenotypes of long COVID, with different etiological pathways and recovery outcomes. This information may inform phenotype-specific approaches to treatment.
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Mavragani A, Sanchez T, Caranci N, Giaquinto C, Barbiellini Amidei C, Canova C. The Association Between Pediatric COVID-19 Vaccination and Socioeconomic Position: Nested Case-Control Study From the Pedianet Veneto Cohort. JMIR Public Health Surveill 2023; 9:e44234. [PMID: 36645419 PMCID: PMC9897308 DOI: 10.2196/44234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/14/2022] [Accepted: 01/06/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The success of pediatric COVID-19 vaccination strongly depends on parents' willingness to vaccinate their children. To date, the role of socioeconomic position (SEP) in pediatric COVID-19 vaccination has not been thoroughly examined. OBJECTIVE We evaluated the association between COVID-19 vaccination and SEP in a large pediatric cohort. METHODS A case-control study design nested into a pediatric cohort of children born between 2007 and 2017, living in the Veneto Region and followed up to at least January 1, 2022, was adopted. Data on children were collected from the Pedianet database and linked with the regional COVID-19 registry. Each child vaccinated with at least one dose of any COVID-19 vaccine between July 1, 2021, and March 31, 2022, was matched by sex, year of birth, and family pediatrician to up to 5 unvaccinated children. Unvaccinated children with a positive outcome on the swab test within 180 days before the index date were excluded from the analyses. Children were geo-referenced to determine their area deprivation index (ADI)-a social and material deprivation measure calculated at the census block level and consisting of 5 socioeconomic items. The index was then categorized in quintiles based on the regional ADI level. The association between ADI quintiles and vaccination status was measured using conditioned logistic regression models to estimate odds ratios and the corresponding 95% CIs. Quantile-g-computation regression models were applied to develop a weighted combination of the individual items to estimate how much each component influenced the likelihood of vaccination. All analyses were stratified by age at vaccination (5-11 and 12-14 years). RESULTS The study population consisted of 6475 vaccinated children, who were matched with 32,124 unvaccinated children. Increasing area deprivation was associated with a lower probability of being vaccinated, with approximately a linear dose-response relationship. Children in the highest deprivation quintile were 36% less likely to receive a COVID-19 vaccine than those with the lowest area deprivation (95% CI 0.59-0.70). The results were similar in the 2 age groups, with a slightly stronger association in 5-11-year-old children. When assessing the effects of the weighted combination of the individual items, a quintile increase was associated with a 17% decrease in the probability of being vaccinated (95% CI 0.80-0.86). The conditions that influenced the probability of vaccination the most were living on rent, being unemployed, and being born in single-parent families. CONCLUSIONS This study has shown a significant reduction in the likelihood of receiving a COVID-19 vaccine among children living in areas characterized by a lower SEP. Findings were robust among multiple analyses and definitions of the deprivation index. These findings suggest that SEP plays an important role in vaccination coverage, emphasizing the need to promote targeted public health efforts to ensure global vaccine equity.
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Affiliation(s)
| | | | - Nicola Caranci
- Regional Health and Social Care Agency, Emilia-Romagna Region, Bologna, Italy
| | - Carlo Giaquinto
- Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Claudio Barbiellini Amidei
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
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Lemon LS, Hauspurg A, Garrard W, Quinn B, Simhan HN. Neighborhood disadvantage and the racial disparity in postpartum hypertension. Am J Obstet Gynecol MFM 2023; 5:100773. [PMID: 36244624 PMCID: PMC10784748 DOI: 10.1016/j.ajogmf.2022.100773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/21/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Postpartum hypertension is the leading cause of postpartum readmission and has long-lasting cardiovascular effects. Black patients have higher incidence rates of hypertensive disorders after delivery and subsequent severe maternal morbidity. Neighborhood advantage, a marker of social determinants of health, has not been studied concerning postpartum hypertension. Moreover, the interplay between race and neighborhood advantage and their effect on postpartum hypertension have not been previously explored. OBJECTIVE This study aimed to evaluate the association between neighborhood-level social determinants of health and postpartum hypertension and explore whether these factors explain previously documented racial disparities. STUDY DESIGN This study included a retrospective cohort of people enrolled in a remote monitoring program of postpartum hypertension at the time of delivery within 1 health network from March 2019 to September 2021. Patients were eligible for enrollment after a diagnosis of hypertensive disorder during pregnancy or delivery. We further limited the cohort to self-reported Black and White patients with blood pressures recorded at 3 weeks and 6 weeks postpartum. The neighborhood advantage for each person at the time of delivery was classified using the area deprivation index, an accepted surrogate of social determinants of health and our primary exposure. The secondary exposure was self-reported race. Study outcomes of interest were hypertensive status (stage 1 hypertension: ≥130 to 139/80 to 89 mm Hg; stage 2 hypertension: ≥140/90 mm Hg) at 3 and 6 weeks after delivery. In addition, hypertensive status by neighborhood area deprivation index using logistic regression was molded. In secondary analyses, a case-control cohort matched on the area deprivation index was created, and conditional logistic regression was used to evaluate race. Finally, mixed-effects models modeling hypertension by race and clustering within the area deprivation index were used. RESULTS Of 4193 people enrolled, 2722 were Black or White and had blood pressure data recorded at 3 weeks after delivery, and 1126 had blood pressure data recorded at 6 weeks after delivery. After accounting for prenatal body mass index, smoking status, type of hypertension, and antihypertensives prescribed at discharge, persons living in the most disadvantaged neighborhoods were twice as likely (adjusted odds ratio, 2.03; 95% confidence interval, 1.53-2.69) to develop stage 2 hypertension at 21 days after delivery and 1.67 times more likely (95% confidence interval, 1.06-2.64) to develop stage 2 hypertension at 6 weeks after delivery than persons living in the most advantaged neighborhoods. Both associations were attenuated after adjusting for race. When people with stage 2 hypertension were matched on area deprivation index with normotensive counterparts, Black patients were still 3 to 4 times more likely to develop stage 2 hypertension at 3 (adjusted odds ratio, 3.00; 95% confidence interval, 1.95-4.63) and 6 (adjusted odds ratio, 4.61; 95% confidence interval, 2.05-10.36) weeks after delivery. This association remained after clustering within a neighborhood at 3 (adjusted odds ratio, 3.12; 95% confidence interval, 2.41-4.06) and 6 (adjusted odds ratio, 2.99; 95% confidence interval, 1.96-4.54) weeks after delivery. There was no significant difference in stage 1 hypertension. CONCLUSION Neighborhood advantage was associated with the development of persistent hypertension at 3 and 6 weeks after delivery. This association did not explain the racial disparity in sustained high blood pressure.
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Affiliation(s)
- Lara S Lemon
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA (Drs Lemon and Hauspurg, Ms Quinn, and Dr Simhan); Department of Clinical Analytics, University of Pittsburgh Medical Center, Pittsburgh, PA (Drs Lemon and Garrard).
| | - Alisse Hauspurg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA (Drs Lemon and Hauspurg, Ms Quinn, and Dr Simhan); Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA (Drs Hauspurg and Simhan)
| | - William Garrard
- Department of Clinical Analytics, University of Pittsburgh Medical Center, Pittsburgh, PA (Drs Lemon and Garrard)
| | - Beth Quinn
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA (Drs Lemon and Hauspurg, Ms Quinn, and Dr Simhan)
| | - Hyagriv N Simhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA (Drs Lemon and Hauspurg, Ms Quinn, and Dr Simhan); Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA (Drs Hauspurg and Simhan)
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Vintimilla R, Seyedahmadi A, Hall J, Johnson L, O’Bryant S. Association of Area Deprivation Index and hypertension, diabetes, dyslipidemia, and Obesity: A Cross-Sectional Study of the HABS-HD Cohort. Gerontol Geriatr Med 2023; 9:23337214231182240. [PMID: 37361029 PMCID: PMC10286155 DOI: 10.1177/23337214231182240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/09/2023] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
Objective: This study aims to investigate the association between neighborhood deprivation and the prevalence of major cardiovascular disease (CVD) risk factors (hypertension, diabetes, dyslipidemia, and obesity) in a Mexican American (MA) population compared to NonHispanic Whites (NHW). Method: A cross-sectional analysis was conducted to include 1,867 subjects (971 MA and 896 NHW). Participants underwent a clinical interview, neuropsychological exam battery, functional examination, MRI of the head, amyloid PET scan, and blood draw for clinical and biomarker analysis. We use the Area Deprivation Index (ADI) Model to assign an ADI score to participants based on their neighborhoods. Descriptive, Cochran-Armitage test for trend, and odds ratio statistical analysis were applied. Results: Our results suggest that NHW had higher odds of having HTN, DM, and obesity in the most deprived neighborhoods, while MA showed no increased odds. The study also found that neighborhood deprivation contributed to diabetes in both MA and NHW and was associated with obesity in NHW. Conclusions: These findings highlighted the importance of addressing both individual and societal factors in efforts to reduce cardiovascular risk. Future research should explore the relationship between socio-economic status and cardiovascular risk in more detail to inform the development of targeted interventions.
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Affiliation(s)
- Raul Vintimilla
- University of North Texas Health Science Center, Fort Worth, USA
| | | | - James Hall
- University of North Texas Health Science Center, Fort Worth, USA
| | - Leigh Johnson
- University of North Texas Health Science Center, Fort Worth, USA
| | - Sid O’Bryant
- University of North Texas Health Science Center, Fort Worth, USA
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Shour AR, Hamberger LK, Meurer J, Kostelac C, Cassidy L. Context Matters: Assessing the Association Between Area Deprivation and the Severity of Injury and Types of Domestic Violence Victimization Among Women. J Interpers Violence 2022; 37:NP22352-NP22374. [PMID: 35098777 DOI: 10.1177/08862605211072209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To analyze the association between social determinants of health (SDOH), as measured by the Area Deprivation Index (ADI), and the severity of injury and types of domestic violence (DV) victimization among women (≥18 years of age) in Milwaukee, Wisconsin. METHODS Neighborhood ADI data from the American Community Survey (2014-2018) were merged with Milwaukee Police Department DV data (2013-2017). ADI included multiple SDOH domains (education, employment, income/poverty, and housing quality). Types of DV were classified using an adaptation of the FBI-Uniform Crime Reporting-Hierarchy Rule, including Crimes Against Persons (homicide/negligent manslaughter, sexual assault/rape, and aggravated battery/assault). Chi-square, Anova tests, and logistic regression analyses were performed using Stata v.14.2; p-values ≤ .05 were considered statistically significant. FINDINGS Except for aggravated battery/assault (OR: 1.003, 95% CI: 1.001-1.010), there was no statistically significant relationship between neighborhood disadvantage and DV victimization in 21,095 DV incidents between 2013 and 2017. Adjusted model results indicate that with each increase in neighborhood disadvantage (by ADI), there was a 1.003 increase in the likelihood for aggravated battery/assault (OR: 1.003, 95% CI: 1.001-1.005). Severity of DV injury was not significantly associated with ADI (OR: 1.002, 95% CI: 0.999-1.004). However, non-Hispanic Black women were 1.3 times more likely than non-Hispanic Whites to be victims of aggravated battery/assault (OR: 1.321, 95% CI: 1.189-1.469). Hispanic women were more likely than non-Hispanic Whites to sustain a more severe injury (OR: 0.841, 95% CI: 0.732-0.970]). CONCLUSION The likelihood of DV-aggravated battery/assault increased with neighborhood deprivation, and significant associations (and highly lopsided prevalence) were found in types of DV victimization by race/ethnicity, with non-Hispanic Black women experiencing higher prevalence than others. This study adds to the body of knowledge by looking at how macro-level neighborhood-SDOH characteristics influence women's exposure to various forms of DV victimization and demonstrated the feasibility of linking law enforcement DV data to SDOH metrics, providing context for law enforcement DV victimizations.
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Affiliation(s)
- Abdul R Shour
- Department of Public Health, 8445Carroll University, Waukesha, WI, USA
- Center for Advancing Population Science, 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - L Kevin Hamberger
- Department of Family Medicine, Division of Residency, 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - John Meurer
- Institute for Health and Equity, 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Constance Kostelac
- Institute for Health and Equity, 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Laura Cassidy
- Institute for Health and Equity, 5506Medical College of Wisconsin, Milwaukee, WI, USA
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Grits D, Emara AK, Klika AK, Murray TG, McLaughlin JP, Piuzzi NS. Neighborhood Socioeconomic Disadvantage Associated With Increased Healthcare Utilization After Total Hip Arthroplasty. J Arthroplasty 2022; 37:1980-1986.e2. [PMID: 35526755 DOI: 10.1016/j.arth.2022.04.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/10/2022] [Accepted: 04/26/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The multifaceted effects of socioeconomic status on healthcare outcomes can be difficult to quantify. The Area Deprivation Index (ADI) quantifies a socioeconomic disadvantage with higher scores indicating more disadvantaged groups. The present study aimed to describe the ADI distribution for primary total hip arthroplasty (THA) patients stratified by patient demographics and to characterize the association of ADI with healthcare utilization (discharge disposition and length of stay [LOS]), 90-day emergency department (ED) visits, and 90-day all cause readmissions. METHODS Two thousand three hundred and ninety one patients who underwent primary elective THA over a 13-month period were included. A multivariable binary logistic regression analysis with outcomes of nonhome discharge, prolonged LOS (>3 days), 90-day ED visits, and 90-day readmission were performed using predictors of ADI, gender, race, smoking status, body mass index, insurance status, and Charlson comorbidity index. Plots of restricted cubic splines were used to graph associations between ADI as a continuous variable and the outcomes of interest using odds ratios. RESULTS In the multivariable regression model, there were statistically significant higher odds of nonhome discharge (OR, 1.82; 95% CI, 1.19-2.77, P = .005) for individuals in the 61-80 ADI quintile as compared to the reference group of 21-40. Individuals in the highest ADI quintile, 81-100, had the greatest odds of nonhome discharge (OR, 2.20; 95% CI, 1.39-3.49, P < .001) and prolonged LOS (OR, 1.91, 95% CI, 1.28-2.84, P = .001). CONCLUSIONS Higher ADI is associated with an increased healthcare utilization within 90 days of THA.
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Affiliation(s)
- Daniel Grits
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Trevor G Murray
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - John P McLaughlin
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Nguyen C, Popescu F, Sommer EC, Adams LB, Barkin S. The Utility of the Brokamp Area Deprivation Index as a Prescreen for Social Risk in Primary Care. J Pediatr 2022; 249:43-9. [PMID: 35779742 DOI: 10.1016/j.jpeds.2022.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To assess the relationship between an Area Deprivation Index (ADI) and a Social Determinant of Health (SDoH) measure within a diverse sample. A prescreening tool based on routinely collected information could reduce clinical burden by identifying patients impacted by SDoH for comprehensive assessment. STUDY DESIGN In total, 499 consented pediatric patient-families who spoke English, Spanish, or Arabic and had a child ≤12 years receiving primary care at a large academic institution were enrolled. Participants completed the Health Leads Social Needs (HLSN) survey. Residential address was extracted from the electronic health record to calculate Brokamp ADI at the census-tract level. The main outcome was the correlations between the total HLSN score and Brokamp ADI, overall and in each language subgroup. ADI distributions were also compared between participants with/without need for each of the 8 HLSN survey SDoH domains, using 2-sample t-tests and Pearson χ2 tests. RESULTS In total, 54.9% of participants were English-speaking, 30.9% were Spanish-speaking, and 14.2% were Arabic-speaking. Spearman correlations between Brokamp ADI and total HLSN score were overall (rs = 0.15; P = .001), English (rs = 0.12; P = .04), Spanish (rs = 0.03; P = .7), and Arabic (rs = 0.24; P = .04). SDoH domain analyses found significant ADI differences between those with/without need in housing instability, childcare, transportation, and health literacy. CONCLUSIONS There were small but statistically significant associations between the Brokamp ADI and total HLSN score and SDoH domains of housing instability, childcare, transportation, and health literacy. These findings support testing the Brokamp ADI as a prescreening tool to help identify patients with social needs in an outpatient clinical setting.
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Zahedi-Spung L, Polnaszek B, Duckham H, Zhang F, Stout MJ, Herrick CJ, Paul R, Carter EB. The Impact of Neighborhood Deprivation on Glycemic Control for Patients with Type 2 Diabetes During Pregnancy. J Womens Health (Larchmt) 2022; 31:1156-1164. [PMID: 35245092 PMCID: PMC9419981 DOI: 10.1089/jwh.2021.0273] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The impact of neighborhood level factors on glycemic control and pregnancy outcomes is understudied. The primary objective was to determine whether there is an association between glycemic control during pregnancy and level of neighborhood deprivation, defined by area deprivation index (ADI). Materials and Methods: We conducted a retrospective cohort study of women with type 2 diabetes who received care at a tertiary referral center from 2007 to 2017. Patients living in more deprived neighborhoods (ADI >85th national percentile) were compared to those living in less deprived neighborhoods (ADI ≤85th percentile). The primary outcome was change in hemoglobin A1c (HbA1c) over time. Demographic characteristics were compared between groups, and trends in mean A1c through each trimester were tested with repeated measures analysis. Results: Of 237 women meeting study criteria, 93 (39.2%) lived in less deprived (low ADI) and 144 (60.8%) lived in more deprived neighborhoods (high ADI). Women living in more deprived neighborhoods were more likely to be Black (86.8% vs. 53.8%, p < 0.01), less likely to be married (11.3% vs. 31.2%, p < 0.01), and had more severe diabetes (p = 0.05). Both groups achieved significant improvement in HbA1c across each trimester using repeated measures analysis. Those living in more deprived neighborhoods had significantly more improvement in HbA1c from their initial visit to the third trimester compared to those in less deprived neighborhoods, (p = 0.01) such that there was no longer a statistically significant disparity in HbA1c by the third trimester (6.69 ± 0.97 Less deprived vs. 6.95 ± 1.22 more deprived, p = 0.19). Conclusions: Low-income women living in more deprived neighborhoods enter pregnancy with significantly worse glycemic control than those living in less deprived neighborhoods, but the gap in glycemic control largely closes by the end of pregnancy with similar maternal and neonatal outcomes.
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Affiliation(s)
- Leilah Zahedi-Spung
- Regional Obstetrical Consultants, University of Tennesse-Chattanooga, Division of Maternal Fetal Medicine, Chattanooga, TN.,Address correspondence to: Leilah Zahedi-Spung, MD, Regional Obstetrical Consultants, Chattanooga, TN 37405, USA
| | - Brock Polnaszek
- Warren Alpert Medical School of Brown University, Providence, RI
| | - Hillary Duckham
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Fan Zhang
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Molly J. Stout
- Division of Maternal Fetal Medicine, University of Michigan, Ann Arbor, MI
| | - Cynthia J. Herrick
- Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Rachel Paul
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Ebony B. Carter
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
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Kamath CC, O’Byrne TJ, Lewallen DG, Berry DJ, Maradit Kremers H. Association of Rurality and Neighborhood Level Socioeconomic Deprivation with Perioperative Health Status in Total Joint Arthroplasty Patients: Analysis from a Large, Tertiary Care Hospital. J Arthroplasty 2022; 37:1505-1513. [PMID: 35337946 PMCID: PMC9356998 DOI: 10.1016/j.arth.2022.03.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Individual socioeconomic status (SES) is associated with disparities in access to care and worse outcomes in total joint arthroplasty (TJA). Neighborhood-level SES measures are sometimes used as a proxy for individual-level SES, but the validity of this approach is unknown. We examined neighborhood level SES and rurality on perioperative health status in TJA. METHODS The study population comprised 46,828 TJA surgeries performed at a tertiary care hospital. Community area deprivation index (ADI) was derived from the 2015 American Census Survey. Logistic regression was used to examine perioperative characteristics by ADI and rurality. RESULTS Compared to patients from the least deprived neighborhoods, patients from the most deprived neighborhoods were likely to be female (odds ratioOR 1.46, 95% confidence interval CI: 1.33-1.61), non-white (OR 1.36, 95% CI: 1.13-1.64), with education high school or less (OR 4.85, 95% CI: 4.35-5.41), be current smokers (OR 2.20, 95% CI: 1.61-2.49), have BMI>30 kg/m2 (OR 1.43, 95% CI: 1.30-1.57), more limitation on instrumental activities of daily living (OR 1.75, 95% CI: 1.55-1.97) and American Society of Anesthesiologists (ASA) score > II (OR 2.0, 95% CI: 1.11-1.37). There was a progressive association between the degree of area level deprivation with preexisting comorbidities. Patients from rural communities were more likely to be male, white, have body mass index (BMI)>30 kg/m2 and lower education levels. However, rurality was either not associated or negatively associated with comorbidities. CONCLUSION TJA patients from lower SES neighborhoods have worse behavioral risk factors and higher comorbidity burden than patients from higher SES neighborhoods. Patients from rural communities have worse behavioral risk factors but not comorbidities.
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Affiliation(s)
- Celia C. Kamath
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Thomas J. O’Byrne
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | | | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hilal Maradit Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota,Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Vassilaki M, Aakre JA, Castillo A, Chamberlain AM, Wilson PM, Kremers WK, Mielke MM, Geda YE, Machulda MM, Alhurani RE, Graff-Radford J, Vemuri P, Lowe VJ, Jack CR, Knopman DS, Petersen RC. Association of neighborhood socioeconomic disadvantage and cognitive impairment. Alzheimers Dement 2022; 19:10.1002/alz.12702. [PMID: 35666244 PMCID: PMC9722980 DOI: 10.1002/alz.12702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/16/2022] [Accepted: 04/28/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION We investigated the association of the area deprivation index (ADI) with cognitive decline, mild cognitive impairment (MCI), and dementia in older adults (≥50 years old). ADI is a neighborhood socioeconomic disadvantage measure assessed at the census block group level. METHODS The study included 4699 participants, initially without dementia, with available ADI values for 2015 and at least one study visit in 2008 through 2018. Using logistic regression and Cox proportional hazards models with age as the time scale, we assessed the odds for MCI and the risk for dementia, respectively. RESULTS In cognitively unimpaired (CU) adults at baseline, the risk for progression to dementia increased for every decile increase in the ADI state ranking (hazard ratio = 1.06, 95% confidence interval (1.01-1.11), P = .01). Higher ADI values were associated with subtly faster cognitive decline. DISCUSSION In older CU adults, higher baseline neighborhood socioeconomic deprivation levels were associated with progression to dementia and slightly faster cognitive decline. HIGHLIGHTS The study used area deprivation index, a composite freely available neighborhood deprivation measure. Higher levels of neighborhood deprivation were associated with greater mild cognitive impairment odds. Higher neighborhood deprivation levels were associated with higher dementia risk.
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Affiliation(s)
- Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Jeremiah A. Aakre
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Anna Castillo
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Alanna M. Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Patrick M. Wilson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Walter K. Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Michelle M. Mielke
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Yonas E. Geda
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona
| | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Rabe E. Alhurani
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
- Department of Internal Medicine, West Suburban Medical Center, Oak Park, Illinois
| | | | | | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Ronald C. Petersen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
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Yu KX, Yuan WJ, Huang CH, Xiao L, Xiao RS, Zeng PW, Chen L, Chen ZH. Socioeconomic deprivation and survival outcomes in patients with colorectal cancer. Am J Cancer Res 2022; 12:829-838. [PMID: 35261805 PMCID: PMC8899994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/07/2022] [Indexed: 06/14/2023] Open
Abstract
Socioeconomic deprivation has been linked to detrimental healthcare outcomes. We sought to examine whether patients with colorectal cancer (CRC) from socioeconomically disadvantaged areas experience worse survival outcomes and how it interacts with other factors. In this population-based study, patients with CRC diagnosed between 2007 to 2015 in the SEER program were reviewed. Socioeconomic deprivation was measured using the Area Deprivation Index (ADI) linked to patients' residence addresses. The effect of ADI on cancer-specific survival and overall survival was evaluated using survival analysis. The Inverse Probability of Weighted (IPW) method and multiple regression was performed to account for the confounding bias. Subgroup analyses were used to test interactions. Multiple mediation analysis was used to estimate the mediating effects. Overall, 266,620 eligible patients were included in further analyses. Compared with low ADI patients, high ADI patients had more unfavorable characteristics and worse cancer-specific (hazard ratio [HR] 1.14, 95% CI 1.12-1.16, P<.001) and overall survival (HR 1.11, 95% CI 1.09-1.12, P<0.001). The results were similar after accounting for confounding factors using the IPW and multiple regression methods. Subgroup analyses revealed the relative robustness of ADI as a prognostic factor. They detected significant interactions between ADI and other covariates on cancer survival, such as age, race, insurance status, disease stage, and receipt of treatment. Multiple mediation analyses identified several factors mediating survival disparities, including anticancer therapy, insurance status, race, marital status, and age. This study suggested that high ADI CRC patients were associated with more unfavorable characteristics at presentation and lower cancer and noncancer survival after treatment than their low ADI counterparts. Multiple factors interacted and mediated these survival disparities associated with the ADI.
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Affiliation(s)
- Ke-Xun Yu
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South UniversityChangsha 410008, Hunan, China
- Department of The Hunan Provincial Key Lab of Precision Diagnosis and Treatment for Gastrointestinal Tumor, Xiangya Hospital of Central South UniversityChangsha 410008, Hunan, China
| | - Wei-Jie Yuan
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South UniversityChangsha 410008, Hunan, China
- Department of The Hunan Provincial Key Lab of Precision Diagnosis and Treatment for Gastrointestinal Tumor, Xiangya Hospital of Central South UniversityChangsha 410008, Hunan, China
| | - Chang-Hao Huang
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South UniversityChangsha 410008, Hunan, China
- Department of The Hunan Provincial Key Lab of Precision Diagnosis and Treatment for Gastrointestinal Tumor, Xiangya Hospital of Central South UniversityChangsha 410008, Hunan, China
| | - Lei Xiao
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South UniversityChangsha 410008, Hunan, China
- Department of The Hunan Provincial Key Lab of Precision Diagnosis and Treatment for Gastrointestinal Tumor, Xiangya Hospital of Central South UniversityChangsha 410008, Hunan, China
| | - Run-Sha Xiao
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South UniversityChangsha 410008, Hunan, China
- Department of The Hunan Provincial Key Lab of Precision Diagnosis and Treatment for Gastrointestinal Tumor, Xiangya Hospital of Central South UniversityChangsha 410008, Hunan, China
| | - Peng-Wei Zeng
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South UniversityChangsha 410008, Hunan, China
- Department of The Hunan Provincial Key Lab of Precision Diagnosis and Treatment for Gastrointestinal Tumor, Xiangya Hospital of Central South UniversityChangsha 410008, Hunan, China
| | - Lu Chen
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South UniversityChangsha 410008, Hunan, China
- Department of The Hunan Provincial Key Lab of Precision Diagnosis and Treatment for Gastrointestinal Tumor, Xiangya Hospital of Central South UniversityChangsha 410008, Hunan, China
| | - Zi-Hua Chen
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South UniversityChangsha 410008, Hunan, China
- Department of The Hunan Provincial Key Lab of Precision Diagnosis and Treatment for Gastrointestinal Tumor, Xiangya Hospital of Central South UniversityChangsha 410008, Hunan, China
- Department of The International Joint Research Center of Minimally Invasive Endoscopic Technology Equipment & Standardization, Xiangya Hospital of Central South UniversityChangsha 410008, Hunan, China
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Chamberlain AM, St Sauver JL, Finney Rutten LJ, Fan C, Jacobson DJ, Wilson PM, Boyd CM, Rocca WA. Associations of Neighborhood Socioeconomic Disadvantage With Chronic Conditions by Age, Sex, Race, and Ethnicity in a Population-Based Cohort. Mayo Clin Proc 2022; 97:57-67. [PMID: 34996566 PMCID: PMC8775356 DOI: 10.1016/j.mayocp.2021.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 09/07/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine the association of socioeconomic status at the census block group level with chronic conditions and to determine whether the associations differ by age, sex, race, or ethnicity. METHODS Adults aged 20 years and older on April 1, 2015, from 7 counties in southern Minnesota were identified using the Rochester Epidemiology Project records-linkage system. We estimated the prevalence of 19 chronic conditions (7 cardiometabolic, 7 other somatic, and 5 mental health conditions) at the individual level and a composite measure of neighborhood socioeconomic disadvantage (the area deprivation index [ADI]) at the census block group level (n=249). RESULTS Among the 197,578 persons in our study, 46.7% (92,373) were male, 49.5% (97,801) were aged 50 years and older, 12.3% (24,316) were of non-White race, and 5.3% (10,546) were Hispanic. The risk of most chronic conditions increased with increasing ADI. For each cardiometabolic condition and most other somatic and mental health conditions, the pattern of increasing risk across ADI quintiles was attenuated, or there was no association across quintiles of ADI in the oldest age group (aged ≥70 years). Stronger associations between ADI and several cardiometabolic, other somatic, and mental health conditions were observed in women. CONCLUSION Higher ADI was associated with increased risk of most chronic conditions, with more pronounced associations in younger persons. For some chronic conditions, the associations were stronger in women. Our findings underscore the importance of recognizing the overall and potentially differential impact of area-level deprivation on chronic disease outcomes for diverse populations.
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Affiliation(s)
- Alanna M Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
| | - Jennifer L St Sauver
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Lila J Finney Rutten
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Chun Fan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Debra J Jacobson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Patrick M Wilson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD
| | - Walter A Rocca
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN; Women's Health Research Center, Mayo Clinic, Rochester, MN
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Adel Fahmideh M, Schraw JM, Chintagumpala M, Lupo PJ, Oluyomi AO, Scheurer ME. Neighborhood Socioeconomic Deprivation and Mortality in Children with Central Nervous System Tumors. Cancer Epidemiol Biomarkers Prev 2021; 30:2278-2285. [PMID: 34620627 PMCID: PMC9058976 DOI: 10.1158/1055-9965.epi-21-0368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/29/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although there is evidence of socioeconomic disparities in survival of children diagnosed with central nervous system (CNS) tumors, the impact of neighborhood socioeconomic deprivation on the survival of these malignancies has not been adequately studied. We investigated the association between area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, and pediatric CNS tumor survival. METHODS Demographic and clinical characteristics, geocoded addresses at diagnosis, and vital status of pediatric CNS tumor cases (n = 5,477) for the period 1995 to 2017 were obtained from the Texas Cancer Registry. ADI scores were computed for census tracts in Texas using the U.S. Census Bureau 2010 geography. Tracts were classified into quartiles as least, third-most, second-most, and most disadvantaged. Children were mapped to quartiles based on residency at diagnosis. The adjusted hazard ratio (HR) and 95% confidence interval (CI) were calculated. RESULTS The results showed a significantly increased HR for death among children in the most (HR, 1.29; 95% CI, 1.09-1.51), second-most (HR, 1.18; 95% CI, 1.01-1.38), and third-most disadvantaged census tracts (HR, 1.18; 95% CI, 1.02-1.37) compared with children in the least disadvantaged tracts. CONCLUSIONS Children living in the most disadvantaged neighborhoods experienced a significantly higher risk of mortality, indicating the important role of socioeconomic disparities in the survival of pediatric CNS tumors. IMPACT The demographic and socioeconomic disparities identified by this study should be considered when planning treatment strategies for these susceptible groups and thus, lead to a better outcome in socioeconomically disadvantaged children diagnosed with CNS tumors.
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Affiliation(s)
- Maral Adel Fahmideh
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas.
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston Texas
| | - Jeremy M Schraw
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston Texas
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas
| | - Murali Chintagumpala
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas
| | - Philip J Lupo
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston Texas
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas
| | - Abiodun Olufemi Oluyomi
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Michael E Scheurer
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston Texas
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas
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Powers BD, Fulp W, Dhahri A, DePeralta DK, Ogami T, Rothermel L, Permuth JB, Vadaparampil ST, Kim JK, Pimiento J, Hodul PJ, Malafa MP, Anaya DA, Fleming JB. The Impact of Socioeconomic Deprivation on Clinical Outcomes for Pancreatic Adenocarcinoma at a High-volume Cancer Center: A Retrospective Cohort Analysis. Ann Surg 2021; 274:e564-e573. [PMID: 31851004 PMCID: PMC7272283 DOI: 10.1097/sla.0000000000003706] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess the impact of a granular measure of SED on pancreatic surgical and cancer-related outcomes at a high-volume cancer center that employs a standardized clinic pathway. SUMMARY OF BACKGROUND DATA Prior research has shown that low socioeconomic status leads to less treatment and worse outcomes for PDAC. However, these studies employed inconsistent definitions and categorizations of socioeconomic status, aggregated individual socioeconomic data using large geographic areas, and lacked detailed clinicopathologic variables. METHODS We conducted a retrospective cohort study of 1552 PDAC patients between 2008 and 2015. Patients were stratified using the area deprivation index, a validated dataset that ranks census block groups based on SED. Multivariable models were used in the curative surgery cohort to predict the impact of SED on (1) grade 3/4 Clavien-Dindo complications, (2) initiation of adjuvant therapy, (3) completion of adjuvant therapy, and (4) overall survival. RESULTS Patients from high SED neighborhoods constituted 29.9% of the cohort. Median overall survival was 28 months. The rate of Clavien-Dindo grade 3/4 complications was 14.2% and completion of adjuvant therapy was 65.6%. There was no evidence that SED impacted surgical evaluation, receipt of curative-intent surgery, postoperative complications, receipt of adjuvant therapy or overall survival. CONCLUSIONS Although nearly one-quarter of curative-intent surgery patients were from high SED neighborhoods, this factor was not associated with measures of treatment quality or survival. These observations suggest that treatment at a high-volume cancer center employing a standardized clinical pathway may in part address socioeconomic disparities in pancreatic cancer.
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Affiliation(s)
- Benjamin D. Powers
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - William Fulp
- Department of Biometrics and Biostatistics, Moffitt Cancer Center, Tampa, Florida
| | - Amina Dhahri
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | | | | | - Luke Rothermel
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Jennifer B. Permuth
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | | | | | - Jose Pimiento
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Pamela J. Hodul
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Mokenge P. Malafa
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Daniel A. Anaya
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | - Jason B. Fleming
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
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Morris MC, Bruehl S, Stone AL, Garber J, Smith C, Palermo TM, Walker LS. Place and Pain: Association Between Neighborhood SES and Quantitative Sensory Testing Responses in Youth With Functional Abdominal Pain. J Pediatr Psychol 2021; 47:446-455. [PMID: 34757421 DOI: 10.1093/jpepsy/jsab113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Neighborhood socioeconomic status (SES) is linked to self-reported pain severity and disability but its association with evoked pain responsiveness in individuals with chronic pain remains unclear. The present study examined relations between neighborhood SES, assessed through the area deprivation index (ADI), and static and dynamic pain response indices. It was hypothesized that youth with functional abdominal pain (FAP) living in lower SES neighborhoods would exhibit lower pain threshold, lower pain tolerance, and reduced conditioned pain modulation (CPM) compared to youth living in higher SES neighborhoods. METHODS Participants were 183 youth with FAP and their parents. Youth completed a quantitative sensory testing protocol. Family addresses were used to compute ADI scores. Thermal stimuli for pain threshold and tolerance were delivered to participants' forearms using thermodes. CPM, an index of descending pain inhibition, was determined using a thermode as test stimulus and a hot water bath as conditioning stimulus. RESULTS As hypothesized, youth with FAP living in lower SES neighborhoods exhibited weaker CPM. Contrary to hypotheses, lower neighborhood SES was associated with neither pain thresholds nor with pain tolerance. CONCLUSIONS These findings demonstrated the independent contribution of place of residence-an often neglected component of the biopsychosocial model-to efficiency of descending pain inhibition. Understanding the mechanisms that account for such associations between place and pain could guide the development of public health and policy initiatives designed to mitigate chronic pain risk in underserved and economically marginalized communities.
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Affiliation(s)
- Matthew C Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amanda L Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Judy Garber
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Craig Smith
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Lynn S Walker
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
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Patterson JA, Keuler NS, Buckingham WR. Differences in Exclusive Breastfeeding Rates in US Hospitals According to Baby-Friendly Hospital Initiative Designation and Area Deprivation Index Category. Breastfeed Med 2021; 16:799-806. [PMID: 34107777 DOI: 10.1089/bfm.2021.0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Disparities in breastfeeding persist placing a greater burden of disease on non-Hispanic black and Hispanic women and infants. Targeted implementation of the Baby-Friendly Hospital Initiative (BFHI) in areas at risk for poor breastfeeding outcomes has been shown to improve disparities in breastfeeding. The area deprivation index (ADI), a measure of the relative socioeconomic disadvantage of a neighborhood, may be useful in exploring the accessibility of BFHI hospitals in highly deprived areas and the differences in exclusive breastfeeding (EBF) rates in hospitals with and without the BFHI designation across deprivation categories. Objective: To evaluate the geographical distribution of BFHI and non-BFHI hospitals across ADI categories and explore the differences in EBF rates in BFHI and non-BFHI hospitals across ADI categories. Methods: Hospital EBF rates obtained from the Joint Commission included 414 BFHI and 1,532 non-BFHI hospitals. State ADI rank scores were determined for each hospital's census block group. Descriptive statistics were used to describe the geographic distribution of BFHI hospitals across three ADI categories (low, medium, and high). EBF rates across ADI categories and BFHI designations were compared using multiway analysis of variance. Results: The distribution of BFHI was similar across all ADI categories, ranging from 18% to 24%. EBF rates were 4.9% lower in highly deprived areas compared to areas with lower deprivation (p < 0.01). BFHI was associated with significantly higher EBF rates across all ADI categories (6.9%-11.2%, p < 0.01). Conclusion: ADI may be a useful tool for targeting the implementation of BFHI in hospitals in highly deprived areas to reduce breastfeeding disparities.
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Affiliation(s)
- Julie A Patterson
- School of Health Studies, College of Health and Human Sciences, Northern Illinois University, DeKalb, Illinois, USA
| | - Nicholas S Keuler
- Department of Statistics, College of Letters and Science, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - William R Buckingham
- Department of Medicine, Center for Health Disparities Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Wrigley-Field E, Garcia S, Leider JP, Van Riper D. COVID-19 Mortality At The Neighborhood Level: Racial And Ethnic Inequalities Deepened In Minnesota In 2020. Health Aff (Millwood) 2021; 40:1644-1653. [PMID: 34524913 PMCID: PMC8562777 DOI: 10.1377/hlthaff.2021.00365] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Substantial racial and ethnic disparities in COVID-19 mortality have been observed at the state and national levels. However, less is known about how race and ethnicity and neighborhood-level disadvantage may intersect to contribute to both COVID-19 mortality and excess mortality during the pandemic. To assess this potential interaction of race and ethnicity with neighborhood disadvantage, we link death certificate data from Minnesota from the period 2017-20 to the Area Deprivation Index to examine hyperlocal disparities in mortality. Black, Indigenous, and people of color (BIPOC) standardized COVID-19 mortality was 459 deaths per 100,000 population in the most disadvantaged neighborhoods compared with 126 per 100,000 in the most advantaged. Total mortality increased in 2020 by 14 percent for non-Hispanic White people and 41 percent for BIPOC. Statistical decompositions show that most of this growth in racial and ethnic disparity is associated with mortality gaps between White people and communities of color within the same levels of area disadvantage, rather than with the fact that White people live in more advantaged areas. Policy interventions to reduce COVID-19 mortality must consider neighborhood context.
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Affiliation(s)
- Elizabeth Wrigley-Field
- Elizabeth Wrigley-Field is an assistant professor in the Department of Sociology and the Minnesota Population Center, University of Minnesota, Twin Cities, in Minneapolis, Minnesota
| | - Sarah Garcia
- Sarah Garcia is a PhD candidate in the Department of Sociology, University of Minnesota, Twin Cities
| | - Jonathon P Leider
- Jonathon P. Leider is a senior lecturer in the Division of Health Policy and Management, University of Minnesota School of Public Health, in Minneapolis, Minnesota, and an associate faculty member at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - David Van Riper
- David Van Riper is the director of spatial analysis at the Institute for Social Research and Data Innovation, University of Minnesota, Twin Cities
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Guhl EN, Zhu J, Johnson A, Essien U, Thoma F, Mulukutla SR, Magnani JW. Area Deprivation Index and Cardiovascular Events: CAN CARDIAC REHABILITATION MITIGATE THE EFFECTS? J Cardiopulm Rehabil Prev 2021; 41:315-321. [PMID: 33758155 PMCID: PMC8410614 DOI: 10.1097/hcr.0000000000000591] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Neighborhood socioeconomic status is associated with health outcomes. Cardiac rehabilitation (CR) provides a cost-effective, multidisciplinary approach to improve outcomes in cardiovascular disease. We aimed to evaluate the association of the Area Deprivation Index (ADI), a marker of neighborhood social composition, with risk of recurrent cardiovascular outcomes and assessed the modifying effect of CR. METHODS We identified patients with a primary diagnosis of (1) myocardial infarction or (2) incident heart failure (HF) admitted to a large-sized regional health center during 2010-2018. We derived the ADI from home addresses and categorized it into quartiles (higher quartiles indicating increased deprivation). We obtained number of CR visits and covariates from the health record. We compared rehospitalization (cardiovascular, acute coronary syndrome [ACS], and HF) and mortality rates across ADI quartiles. RESULTS We included 6957 patients (age 69.2 ± 13.4 yr, 38% women, 89% White race). After covariate adjustment, the ADI was significantly associated with higher incidence rates (IRs)/100 person-yr of cardiovascular rehospitalization (quartile 1, IR 34.6 [95% CI, 31.2-38.2]; quartile 4, 41.5 [95% CI, 39.1-44.1], P < .001). In addition, the ADI was significantly associated with higher rates of rehospitalization for HF (P < .001), ACS (P < .012), and all-cause mortality (P < .04). These differences in rehospitalization and mortality rates by the ADI were no longer significant in those who attended CR. CONCLUSIONS We found the increased ADI was adversely associated with rehospitalizations and mortality. However, in individuals with CR, outcomes were significantly improved compared with those with no CR. Our findings suggest that CR participation has the potential to improve outcomes in disadvantaged neighborhoods.
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Affiliation(s)
- Emily N. Guhl
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Jianhui Zhu
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Amber Johnson
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Utibe Essien
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Center for Health Equity Research and Promotion, VA Pittsburgh, Healthcare System
| | - Floyd Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Suresh R. Mulukutla
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Jared W. Magnani
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Shaw JH, Wesemann LD, Ayoola AS, Les CM, Charters MA, North WT. Comparison of Area Deprivation Index, Socioeconomic Parameters, and Preoperative Demographics With Postoperative Emergency Department Visits After Total Knee Arthroplasty. J Arthroplasty 2021; 36:2788-94. [PMID: 33902984 DOI: 10.1016/j.arth.2021.03.058] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/28/2021] [Accepted: 03/31/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aims to determine if socioeconomic (SE) parameters, primarily area deprivation index (ADI), relate to postoperative emergency department (ED) visits after total knee arthroplasty (TKA). METHODS We retrospectively reviewed 2655 patients who underwent TKA in a health system of 4 hospitals. The primary outcome was an ED visit within 90 days, which was divided into those with and without readmission. SE parameters including ADI as well as preoperative demographics were analyzed. Univariable and multiple logistic regressions were performed determining risk of 90-day postoperative ED visits, as well as once in the ED, risks for readmission. RESULTS 436 patients (16.4%) presented to the ED within 90 days. ADI was not a risk factor. The multiple logistic regression demonstrated men, Medicare or Medicaid, and preoperative ED visits were consistently risk factors for a postoperative ED visit with and without readmission. Preoperative anticoagulation was only a risk factor for ED visits with readmission. Among patients who visited the ED, if the patient was Caucasian, a lower BMI, or higher American Society of Anesthesiologists score, they were likely to be readmitted. CONCLUSION The study demonstrated that the percentage of early ED returns after TKA was high and that ADI was not a predictor for 90-day postoperative ED visit. The only SE factor that may contribute to this phenomenon was insurance type. Once in the ED, race, preoperative ED visits, preoperative anticoagulation, BMI, gender, and preoperative American Society of Anesthesiologists score contributed to a risk of readmission. The study supports hospitals' mission to provide equal access health care.
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Kitchen C, Hatef E, Chang HY, Weiner JP, Kharrazi H. Assessing the association between area deprivation index on COVID-19 prevalence: a contrast between rural and urban U.S. jurisdictions. AIMS Public Health 2021; 8:519-530. [PMID: 34395702 PMCID: PMC8334638 DOI: 10.3934/publichealth.2021042] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/15/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has impacted communities differentially, with poorer and minority populations being more adversely affected. Prior rural health research suggests such disparities may be exacerbated during the pandemic and in remote parts of the U.S. OBJECTIVES To understand the spread and impact of COVID-19 across the U.S., county level data for confirmed cases of COVID-19 were examined by Area Deprivation Index (ADI) and Metropolitan vs. Nonmetropolitan designations from the National Center for Health Statistics (NCHS). These designations were the basis for making comparisons between Urban and Rural jurisdictions. METHOD Kendall's Tau-B was used to compare effect sizes between jurisdictions on select ADI composites and well researched social determinants of health (SDH). Spearman coefficients and stratified Poisson modeling was used to explore the association between ADI and COVID-19 prevalence in the context of county designation. RESULTS Results show that the relationship between area deprivation and COVID-19 prevalence was positive and higher for rural counties, when compared to urban ones. Family income, property value and educational attainment were among the ADI component measures most correlated with prevalence, but this too differed between county type. CONCLUSIONS Though most Americans live in Metropolitan Areas, rural communities were found to be associated with a stronger relationship between deprivation and COVID-19 prevalence. Models predicting COVID-19 prevalence by ADI and county type reinforced this observation and may inform health policy decisions.
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Affiliation(s)
- Christopher Kitchen
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elham Hatef
- Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Hsien Yen Chang
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jonathan P Weiner
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hadi Kharrazi
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Goitia J, Phan DQ, Lee MS, Moore N, Mansukhani P, Aharonian V, Brar SS, Zadegan R. The role of neighborhood disadvantage in predicting mortality in patients after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2021; 98:E938-E946. [PMID: 34259367 DOI: 10.1002/ccd.29872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/10/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Neighborhoods have a powerful impact on health. Prior investigations into disparities associated with transcatheter aortic valve replacement (TAVR) have focused on race and access to the procedure. We sought to investigate the role of neighborhood disadvantage on mortality post-TAVR. METHODS Patients who underwent TAVR at Kaiser Permanente Los Angeles Medical Center between June, 2011 and March, 2019 were evaluated. Neighborhood disadvantage was defined using the area deprivation index, an established and validated index that considers multiple socioeconomic metrics. Cutoffs used for disadvantage were national percentile ≥25% and state decile ≥6. Cox proportional hazards regression analysis was used to assess outcomes. RESULTS A total of 668 patients (age 82.1 ± 7.5 years, 49% female) were included, of which 215 (32.2%) were from disadvantaged neighborhoods by state decile, and 167 (25%) by national percentile. At a median follow-up of 18.8 months (interquartile range 8.7-36.5 months), neighborhood disadvantage was independently associated with increased all-cause mortality (National percentile: hazard ratio [HR] 1.91, 95% confidence interval [CI] 1.35-2.69; state decile: HR 1.68, 95% CI 1.21-2.34). On propensity scored analysis, neighborhood disadvantaged remained independently associated with increased all-cause mortality (National percentile: IPTW HR 1.86, 95% CI 1.52-2.28, PSM HR 1.67, 95% CI 1.11-2.51; state decile: IPTW HR 1.55, 95% CI 1.26-1.91, PSM HR 2.0, 95% CI 1.33-2.99). CONCLUSION Living in a disadvantaged neighborhood was independently associated with increased mortality post-TAVR on multivariate and propensity score matched analysis. Further investigations into the role of neighborhood disadvantage are needed to address disparities and improve outcomes post-TAVR.
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Affiliation(s)
- Jesse Goitia
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Derek Q Phan
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles, California, USA
| | - Ming-Sum Lee
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Naing Moore
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles, California, USA
| | - Prakash Mansukhani
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles, California, USA
| | - Vicken Aharonian
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles, California, USA
| | - Somjot S Brar
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles, California, USA
| | - Ray Zadegan
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles, California, USA
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Lee J, Fernando SJ, Malenke JA, Totten DJ, Kloosterman N, Langerman A, Kim YJ, Mannion K, Sinard R, Netterville J, Rohde SL. Socioeconomic Influences on Short-term Postoperative Outcomes in Patients With Oral Cavity Cancer Undergoing Free Flap Reconstruction. Otolaryngol Head Neck Surg 2021; 166:274-281. [PMID: 34030493 DOI: 10.1177/01945998211012954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the associations between median household income (MHI) and area deprivation index (ADI) on postoperative outcomes in oral cavity cancer. STUDY DESIGN Retrospective review (2000-2019). SETTING Single-institution tertiary medical center. METHODS MHI and ADI were matched from home zip codes. Main postoperative outcomes of interest were length of tracheostomy use, length of hospital stay, return to oral intake, discharge disposition, and 60-day readmissions. Linear and logistic regression controlled for age, sex, race, body mass index, tobacco and alcohol use history, primary tumor location, disease staging at presentation, and length of surgery. A secondary outcome was clinical disease staging (I-IV) at time of presentation. RESULTS The cohort (N = 681) was 91.3% White and 38.0% female, and 51.7% presented with stage IV disease. The median age at the time of surgery was 62 years (interquartile range [IQR], 53-71). The median MHI was $47,659 (IQR, $39,324-$58,917), and the median ADI was 67 (IQR, 48-79). ADI and MHI were independently associated with time to return of oral intake (β = 0.130, P = .022; β = -0.092, P = .045, respectively). Neither was associated with length of tracheostomy, hospital stay, discharge disposition, or readmissions. MHI quartiles were associated with a lower risk of presenting with more advanced disease (Q3 vs Q1: adjusted odds ratio, 0.56 [95% CI, 0.32-0.97]). CONCLUSION MHI is associated with oral cavity cancer staging at the time of presentation. MHI and ADI are independently associated with postoperative return to oral intake following intraoral tumor resection and free flap reconstruction.
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Affiliation(s)
- Jaclyn Lee
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Shanik J Fernando
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jordan A Malenke
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Douglas J Totten
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | | | - Alexander Langerman
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Young J Kim
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kyle Mannion
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert Sinard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Netterville
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah L Rohde
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Alishlash AS, Rutland SB, Friedman AJ, Hampton JI, Nourani A, Lebensburger J, Oates GR. Acute chest syndrome in pediatric sickle cell disease: Associations with racial composition and neighborhood deprivation. Pediatr Blood Cancer 2021; 68:e28877. [PMID: 33405365 DOI: 10.1002/pbc.28877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Acute chest syndrome (ACS) is the leading cause of death for children with sickle cell disease (SCD). Recurrent ACS has detrimental effects on pulmonary health and health care costs. Neighborhood characteristics affect the outcomes of many pediatric chronic diseases, but their role in SCD is not well studied. In this study, we investigated the effects of area-level socioeconomic deprivation and racial composition on the recurrence of ACS. STUDY DESIGN We performed a retrospective cross-sectional analysis of clinical data from a large pediatric SCD center. Patients' residential addresses were geocoded and linked to a composite area deprivation index (ADI) and percent African American population at the level of Census block groups. The association of recurrent ACS with neighborhood characteristics was evaluated using logistic regression analysis. RESULTS The sample included 709 children with SCD. Residence in a socioeconomically deprived neighborhood was associated with 27% less risk of recurrent ACS, and residence in a predominantly African American neighborhood was associated with 41% less risk of ACS recurrence. The racial composition explained the protective effect of living in a high-deprivation area after adjusting for sociodemographic and clinical covariates. Demographic and clinical factors associated with recurrent ACS included older age, male gender, asthma, hydroxyurea use, and chronic transfusion therapy. CONCLUSIONS This is the first study to report a protective effect of residing in a predominantly African American community for ACS recurrence. Further prospective studies are needed to confirm the association and to understand the mechanisms of such relationship.
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Affiliation(s)
| | - Sarah B Rutland
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Jane I Hampton
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Anis Nourani
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey Lebensburger
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gabriela R Oates
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
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Vasiliadis HM, Gontijo Guerra S, Berbiche D, Pitrou IE. The Factors Associated with 3-Year Mortality Stratified by Physical and Mental Multimorbidity and Area of Residence Deprivation in Primary Care Community-Living Older Adults. J Aging Health 2021; 33:545-556. [PMID: 33779356 PMCID: PMC8236670 DOI: 10.1177/0898264321997715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: To examine the risk factors of mortality stratified by physical and mental multimorbidity (PMM) and area socioeconomic status. Methods: Cox regression analyses were used to study 3-year all-cause mortality in primary care older adults stratified by PMM status, and area of residence material and social deprivation. Results: There were socioeconomic differences in the associations between PMM and mortality. Continuity of care decreased mortality risk in moderately and most deprived areas. Satisfaction with medical consultations decreased mortality risk in moderately deprived areas. Current smoking increased mortality in those living in moderately and most deprived areas. Physical activity reduced mortality only in individuals without PMM. Higher cognition was associated with reduced mortality in individuals living in moderately deprived areas. Discussion: Public health policies should be further encouraged in primary care, aiming at increased continuity of care, quality of interactions with patients, and prevention strategies including smoking cessation programs and physical activity promotion.
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Affiliation(s)
- Helen-Maria Vasiliadis
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada.,Charles-Le Moyne Innovations in Health Research Center (CR-CSIS), Longueuil, QC, Canada
| | - Samantha Gontijo Guerra
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada.,Charles-Le Moyne Innovations in Health Research Center (CR-CSIS), Longueuil, QC, Canada
| | - Djamal Berbiche
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada.,Charles-Le Moyne Innovations in Health Research Center (CR-CSIS), Longueuil, QC, Canada
| | - Isabelle E Pitrou
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada.,Charles-Le Moyne Innovations in Health Research Center (CR-CSIS), Longueuil, QC, Canada
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Molina AL, Molina Y, Walley SC, Wu CL, Zhu A, Oates GR. Residential instability, neighborhood deprivation, and pediatric asthma outcomes. Pediatr Pulmonol 2020; 55:1340-1348. [PMID: 32275809 DOI: 10.1002/ppul.24771] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/26/2020] [Accepted: 03/29/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Limited work has directly compared the role of different neighborhood factors or examined their interactive effects on pediatric asthma outcomes. Our objective was to quantify the main and interactive effects of neighborhood deprivation and residential instability (RI) on pediatric asthma outcomes. METHODS We conducted a retrospective cross-sectional study of patients with a primary diagnosis of asthma hospitalized at a tertiary care pediatric hospital. Residential addresses at the index hospitalization were linked to the state area deprivation index (ADI). RI was coded as the number of residences in the past 4 years. Logistic and ordinal regression and Cox regression survival analyses were used to estimate the effect on the primary outcomes of chronic asthma severity (intermittent, mild persistent, moderate persistent, severe persistent/other) as defined by the National Heart, Lung, and Blood Institute, severe hospitalization (requiring continuous albuterol or intensive care unit care), and time to emergency department (ED) readmission and rehospitalization within 365 days of the index visit, respectively. RESULTS In the sample (N = 664), 21% had severe persistent/other asthma, 22% had severe hospitalization, 37% were readmitted to the ED, and 19% were rehospitalized. Increasing RI was independently associated with more severe chronic asthma (odds ratio = 1.18, 95% confidence interval [CI] = 1.05, 1.32, P = .004), greater risk of 365-day ED readmission (hazard ratio [HR] = 1.10, 95% CI = 1.05, 1.15, P < .0001), and greater risk of 365-day rehospitalization (HR = 1.09, 95% CI = 1.03, 1.14, P = .002). There were no significant associations between ADI and these outcomes. Further, we did not find significant evidence of interactive effects. CONCLUSIONS RI appears to be modestly associated with pediatric asthma outcomes, independent of current neighborhood deprivation.
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Affiliation(s)
- Adolfo L Molina
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Yamilé Molina
- School of Public Health, Division of Community Health Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Susan C Walley
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Chang L Wu
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aowen Zhu
- Department of Pediatrics, Division of Pediatric Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gabriela R Oates
- Department of Pediatrics, Division of Pediatric Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Galiatsatos P, Woo H, Paulin LM, Kind A, Putcha N, Gassett AJ, Cooper CB, Dransfield MT, Parekh TM, Oates GR, Barr RG, Comellas AP, Han MK, Peters SP, Krishnan JA, Labaki WW, McCormack MC, Kaufman JD, Hansel NN. The Association Between Neighborhood Socioeconomic Disadvantage and Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:981-993. [PMID: 32440110 PMCID: PMC7211318 DOI: 10.2147/copd.s238933] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 04/20/2020] [Indexed: 01/10/2023] Open
Abstract
Rationale Individual socioeconomic status has been shown to influence the outcomes of patients with chronic obstructive pulmonary disease (COPD). However, contextual factors may also play a role. The objective of this study is to evaluate the association between neighborhood socioeconomic disadvantage measured by the area deprivation index (ADI) and COPD-related outcomes. Methods Residential addresses of SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) subjects with COPD (FEV1/FVC <0.70) at baseline were geocoded and linked to their respective ADI national ranking score at the census block group level. The associations between the ADI and COPD-related outcomes were evaluated by examining the contrast between participants living in the most-disadvantaged (top quintile) to the least-disadvantaged (bottom quintile) neighborhood. Regression models included adjustment for individual-level demographics, socioeconomic variables (personal income, education), exposures (smoking status, packs per year, occupational exposures), clinical characteristics (FEV1% predicted, body mass index) and neighborhood rural status. Results A total of 1800 participants were included in the analysis. Participants residing in the most-disadvantaged neighborhoods had 56% higher rate of COPD exacerbation (P<0.001), 98% higher rate of severe COPD exacerbation (P=0.001), a 1.6 point higher CAT score (P<0.001), 3.1 points higher SGRQ (P<0.001), and 24.6 meters less six-minute walk distance (P=0.008) compared with participants who resided in the least disadvantaged neighborhoods. Conclusion Participants with COPD who reside in more-disadvantaged neighborhoods had worse COPD outcomes compared to those residing in less-disadvantaged neighborhoods. Neighborhood effects were independent of individual-level socioeconomic factors, suggesting that contextual factors could be used to inform intervention strategies targeting high-risk persons with COPD.
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Affiliation(s)
- Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Han Woo
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura M Paulin
- Pulmonary and Critical Care, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Amy Kind
- University of Wisconsin School of Medicine and Public Health, Department of Medicine Health Services and Care Research Program and Division of Geriatrics, Madison, WI, USA.,Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI, USA
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Christopher B Cooper
- Department of Medicine, University of California Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Mark T Dransfield
- Department of Medicine, University of Alabama Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Trisha M Parekh
- Department of Medicine, University of Alabama Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Gabriela R Oates
- Department of Medicine, University of Alabama Birmingham, Birmingham, AL, USA
| | - R Graham Barr
- Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | | | - Meilan K Han
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Stephen P Peters
- Department of Medicine, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Jerry A Krishnan
- Department of Medicine, University of Illinois, Chicago, IL, USA
| | - Wassim W Labaki
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joel D Kaufman
- Office of the Dean, University of Washington School of Public Health, Seattle, WA, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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